Recent experience with Lumbar Canal Stenosis Surgery

Well, its been again a very long time since i wrote on my blog. Epidural steroid injections are a common treatment in this part of the country to avoid surgery in a patient having lumbar canal stenosis. I personally really fail to understand , why we really need to give steroid injection in a patient with lumbar canal stenosis. Steroid are used to treat inflammation in the management of root pain. In case of stenosis, probably epidural injections might work by breaking some of the adhesion of the root but for that do we really need a steroid injection? well, i personally do not think so. If at all we want to use epidural injection isn;t it better to put epidural saline injection?

What infact happens if we repeatedly use epidural steroid injection that i experienced in few of my surgeries. When a patient with stenosis receives repeated steroid injections, due to reactive reactions there forms a fibrous cover over the dura which is very densely adhered to the dura and that makes dura totally immobile. To remove that particular fibrous cover is also a nightmare for a surgeon. I operated two of such cases very recently. I could remove that cover and make patient all right completely but took a long surgical time to remove that cover. It was easy relatively because i always use microscope to decompress the root.

So , my personal opinion is if we are planning a surgery in a patient with stenosis... we should not give steroids into the epidural space but we should , if at all we want, epidural saline injection.